This article deals with the development of drug services in Stockholm, Sweden since the mid-1990s. Initially, data were collected as part of a European Union comparative study of the development of drug services in six major European cities. However, the present article uses these data to analyse to what extent the traditional 'Swedish model' of dealing with narcotic drugs can be said to have come to a crossroad. The article describes and analyses changes in drug use, and in the structure, organization and utilization of social services based, as well as healthcare-based drug services in Stockholm during the past decade. As pointed out in the article, the 'drug-free society' is still the ultimate goal of Swedish drug policy. However, as the Stockholm example hints, when it comes to the care and treatment of individual drug problems, there seems to be an on-going shift, from in-patient treatment towards measures such as substitution treatment, outpatient care and housing. The article discusses whether these changes signify a softening of Sweden's restrictive drug policy, or whether they rather point to a 're-medicalization' of drug services, and shift in focus from 'cure' and social re-integration towards a focus on 'care' and on attempts to avoid 'public nuisance'.

This article reports the results of a purposive review of the different alcohol survey instruments currently used in survey research. The review was conducted to support the development of a standardized comparative survey methodology for Europe. It examines various types of instruments used to measure alcohol consumption, risky drinking, alcohol abuse and dependence, social consequences and third-party harm. The review of literature provides several insights for a European comparative survey. The beverage-specific quantity-frequency measure is recommended for use across countries. A reference period of 1 year for alcohol consumption is considered important if one is to link associated problems with alcohol intake. With regard to risky drinking, objective measures based on the quantity of approximately 60-70 g of ethanol per drinking occasion are preferable to subjective measures of drunkenness. In choosing an instrument for measuring abuse and dependence, the key issue is to decide whether the instrument is to serve as a screening or diagnostic tool. In the case of screening, the Alcohol Use Disorders Identification Test or the Rapid Alcohol Problem Screen-4 appears more appropriate. But if one desires to approximate a diagnostic category, then the Composite International Diagnostic Interview or another operationalization of ICD-10/DSM-IV criteria would be the better choice. Due to a lack of validated scales for social consequences and third-party harm, no recommendations are justified.

Introduction: The aim of the present study was to investigate the association between exposure to fathers' alcohol consumption and offspring's own risk of alcohol-related hospitalization. Methods: Data on circumstances in childhood and adolescence, e.g. fathers' alcohol consumption at different levels (never, rarely, occasionally, often), parental divorce, as well as offspring's own risky use of alcohol, smoking and mental health were collected among 49,321 men (sons), born in 1949-51, during conscription for compulsory military training in 1969/70, i.e. at ages 18-20. Data on alcohol-related diagnoses were collected from the Swedish In-patient Care register 1973-2009. Results: The relative risk of alcohol-related diagnoses among sons after the age of 20 increased with increasing level of alcohol consumption in the fathers. Compared with sons whose fathers never drank alcohol, those with fathers who drank alcohol occasionally or often had an increased hazard ratio (HR) of later hospitalization with alcohol-related diagnoses of 1.77 (95% confidence interval (CI)=1.57-1.99) and 3.69 (CI 95% = 3.16-4.32), respectively. The associations were markedly stronger when the men were followed from age 40 and onwards compared with follow-up between 20 and 40 years of age. Conclusion: Father's alcohol consumption was associated with an increased relative risk of alcohol-related hospitalization in offspring in adulthood.

Aims: This study investigated past month patternsand risk factors of alcohol, tobacco and cannabis useby level of intensity in the German generalpopulation. Methods: Data from the 2006 GermanEpidemiological Survey of Substance Abuse (ESA)were used. The cross-sectional random sampleconsisted of N¼7912 adults aged 18–64 years. Theresponse rate was 45%. Intensive use of eachsubstance was measured applying substance-specificcut-off points: alcohol: 420/30 g pure ethanol dailyfor women/men; tobacco: 20 cigarettes daily;cannabis: on 6 occasions monthly. Findings: The majority of substance users reportedno intensive use of any of the three substances(77.5%) and 19.4% had used one of the threesubstances intensively. A total of 3.1% engaged inintensive use of multiple substances with alcohol andtobacco (2.3%) as the most prevalent pattern. Ahigher risk for intensive use of multiple substanceswas found among males, older individuals and thosewith a substance use disorder. Conclusions: Results of this study call for anintegrated view on substance use and relateddisorders in prevention and treatment, takingdiverse use patterns and specific needs of substanceabusers into account.

Objective: A number of studies have investigated early life determinants of alcohol consumption in adolescence. In this study, we will investigate early life predictors of high alcohol consumption in middle age. Methods: Data on early life predictors, e.g. alcohol consumption and smoking, was collected from 49,321 Swedish men born 1949-1951 at conscription for military service in 1969/70. Follow-up data on alcohol consumption in the same men was collected from a random sample participating in one of the Swedish Survey of Living Condition in 1988/89, 1996/97 or 2004/05 (N=146), i.e. at age 37 or later. Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were estimated in logistic regression analysis for the association between factors measured in late adolescence and high alcohol consumption middle-age. Results: The proportion of high consumers of alcohol increased from late adolescence to middle age. Smoking (OR 2.9, CI95% 1.3-6.2) and low education (OR 2.0, CI95% 1.0-4.0) measured at the conscription examination in late adolescence were associated with high alcohol consumption in middle age. A few other factors measured at the conscription examination, e.g. high alcohol consumption (OR 1.8, CI95% 0.7-4.4), showed elevated ORs but the associations were not significantly increased. Conclusion: Smoking and low education measured in late adolescence were associated with high alcohol consumption in middle age.

Introduction: The study investigates health and social conditions among pregnant substance abusers and the children that were born from these pregnancies, and analyses outcomes in relation to type of substance abuse.

Results: The women presented a multitude of problems, including low education, substance abusing partners, and elevated smoking rates. Compared with the population, more children were born prematurely and average birth weight was almost 350 g lower. About 14% were diagnosed as being affected by maternal substance abuse. During follow-up, 5 women died and 88% showed continued substance-related mental and health problems. All children survived and 85% experienced placement in out-of-home care. Purchase of psychotropic drugs and mental health problems were more common among women with alcohol as one drug of preference.

Conclusions: Parenthood did not represent a turning point for pregnant substance abusers. Comprehensive and persistent support is necessary, but in the short-term, efforts should be made to curb excessive smoking rates. The children faced several disadvantages at birth, but a longer follow-up is required to assess the impact of maternal substance abuse properly.

Aims: The aim of this qualitative research is to show how the alcohol socialization process - i.e. the ways children and young people get acquainted with alcohol - can generate very diverse experiences and meanings in different cultural contexts. Method: A total of 16 focus groups were conducted in Italy and Finland, divided by age (4 groups), gender and socio-cultural level. A total of 190 participants took part in the study. Findings: The findings support the hypothesis that the alcohol socialization process takes place in very different ways and assumes diverse meaning in the two countries involved in the study. In Italy the relationship with alcohol takes place as part of a gradual process and participants' first memories of drinking alcohol are connected to positive values. In Finland, on the other hand, often the first experiences of drinking overlap with the first experiences of intoxication and alcohol images reflect an ambiguous relation with this substance, closely related to its intoxicating effects. Conclusions: Results show that the alcohol socialization process can take very different forms and meanings according to a specific drinking cultures. Thus, further comparative research should take into more consideration the implication of these substantial differences.

Aims: The purpose of this article is to review community-based evaluations of street drinking bans, with a view to understanding the effectiveness of these laws in reducing alcohol-related harm and benefiting the community.

Methods: Sixteen evaluations across 13 locations (in the UK, New Zealand and Australia) were identified. Nine themes were drawn out of the content and thematic analysis.

Conclusions: There is no evidence that street drinking bans reduce alcohol-related harm or benefit the community in the other ways (aside from perceptions of safety and improvement to amenity). However, the methodological limitations of the evaluations reviewed make it difficult to draw conclusions about the effectiveness or otherwise of street drinking bans. More rigorous evaluations of the effectiveness and impacts of street drinking laws need to be undertaken given their continued proliferation across Australia and other Western countries.

There has been growing academic interest in drinking cultures as targets of investigation and intervention, driven often by policy discourse about changing the drinking culture. In this article, we conduct a critical review of the alcohol research literature to examine how the concept of drinking culture has been understood and employed, particularly in work that views alcohol through a problem lens. Much of the alcohol research discussion on drinking culture has focussed on national drinking cultures in which the cultural entity of concern is the nation or society as a whole (macro-level). In this respect, there has been a comparative tradition concerned with categorising drinking cultures into typologies (e.g. wet and dry cultures). Although overtly focused on patterns of drinking and problems at the macro-level, this tradition also points to a multifaceted understanding of drinking cultures. Even though norms about drinking are not uniform within and across countries there has been relatively less focus in the alcohol research literature on cultural entities below the level of the culture as a whole (micro-level). We conclude by offering a working definition, which underscores the multidimensional and interactive nature of the drinking culture concept.

Aims: In this study, we highlight the identities and actions of women with a problem-drinking relative by analysing autobiographies of women born between the 1920s and the 1950s. We ask how women describe their relationship and the problems arising because of a significant other’s drinking and how they cope with these problems. Methods: In the analysis, we pay attention to the power dynamics between family members. We, first, trace what kind of positions or identities the protagonists take in relation to the drinker. Second, we examine what kinds of harms and emotional reactions significant other’s drinking causes. Third, we consider how writers identify or take distance from events described in the autobiographies. Findings: Our analysis reveals four main identities and coping strategies: the positions of victim, helper, boundary setter and fighter. The victim and helper positions often entail women’s weakness and oppressed role, while the positions of boundary setter and fighter express women’s own power and reflexivity in action. Conclusions: Knowledge of the identities and coping strategies is important for understanding the power aspects of a relationship and developing appropriate support for women suffering from family member’s drinking.

Aims: This study analyses how Finnish and Norwegian teenagers and parents of teenagers perceive the appropriateness, desirability or harmfulness of different drinking situations. The focus is on whether teenagers and parents perceive the situations similarly or differently.

Methods: Our data consist of focus group interviews from Finland and Norway with teenagers aged 14–17 years (n = 8 groups, n = 44 participants) and parents (n = 8 groups, n = 38). Three pictures portraying different drinking situations were presented to the participants, who were asked to describe (1) what kind of situation the picture depicts, (2) whether the way of drinking in the picture was acceptable or not and (3) whether they identified with the situation or not.

Findings: Our analysis showed that teenagers and parents defined the situations similarly and applied rather similar criteria when assessing the appropriateness of drinking. The most important criteria related to the amount and the way of drinking, and whether or not children were present in the situation. Regarding the identification with the situations, teenagers seemed to have somewhat stricter attitudes towards intoxication than adults, which can be perceived as a sign of an ongoing trend of decreasing youth drinking.

Conclusions: Overall, our analysis suggests that the alcohol worlds of parents and teenagers resembled each other, supporting the notion that the generational gap between parents and teenagers is diminishing.

The following block of texts is a result of co-operation within the International Society of Addiction Journal Editors. Three editors, Betsy Thorn, Irmgard Eisenbach-Stangl and Kerstin Stenius decided to compile a group of commentaries upon a theme that seems to be of interest in different parts of Europe: The changes in the division of labour between the public sector and civil society in the control and enforcement of public order, drug use and criminality. These four texts give examples of how the civil society presently reacts to social insecurity and fear of drug users, street violence and criminality.